Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder

Abstract

BACKGROUND

Electroconvulsive therapy (ECT) is both an effective treatment for patients with major depressive disorder (MDD) and a noxious stimulus. Although some studies have explored the effect of sedation depth on seizure parameters in ECT, there is little research on the noxious stimulation response to ECT. In this study, we used two electroencephalography (EEG)-derived indices, the quantitative consciousness (qCON) index and quantitative nociceptive (qNOX) index, to monitor sedation, hypnosis, and noxious stimulation response in patients with MDD undergoing acute ECT.

AIM

To evaluate the effect of anesthesia depth based on the qCON and qNOX indices on seizure parameters.

METHODS

Patients with MDD (n = 24) underwent acute bilateral temporal ECT under propofol anesthesia. Before ECT, the patients were randomly divided into three groups according to qCON scores (qCON60-70, qCON50-60, and qCON40-50). Continuous qCON monitoring was performed 3 minutes before and during ECT, and the qCON, qNOX, vital signs, EEG seizure parameters, and complications during the recovery period were recorded. The 24-item Hamilton Rating Scale for Depression, Zung’s Self-rating Depression Scale, and Montreal Cognitive Assessment scores were evaluated before the first ECT session, after the fourth ECT session, and after the full course of ECT.

RESULTS

A total of 193 ECT sessions were performed on 24 participants. The qCON index significantly affected the EEG seizure duration, peak mid-ictal amplitude, and maximum heart rate during ECT (P < 0.05). The qNOX index significantly affected the post-ictal suppression index (P < 0.05). Age, number of ECT sessions, and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters (P < 0.05). However, there were no significant differences in complications, 24-item Hamilton Rating Scale for Depression scores, Zung’s Self-rating Depression Scale scores, or Montreal Cognitive Assessment scores among the three groups (P > 0.05).

CONCLUSION

Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.

Keywords: Electroconvulsive therapy; Propofol; Nociception; Depression; Electroencephalogram

Core Tip: Anesthesia depth based on quantitative consciousness index and quantitative nociceptive index affects electroconvulsive therapy (ECT) seizure parameters during acute ECT in patients with major depressive disorder. Electrical stimulation at a quantitative consciousness index of 60-70 will improve electroencephalography seizure parameters while not increasing complications. The quantitative nociceptive index had a significant effect on post-ictal suppression index, and patients with higher post-ictal suppression index may suffer from greater noxious stimulation during ECT. We should not only consider the effect of sedation depth on the quality of seizure but also the degree of noxious stimulation brought by the treatment technology itself during ECT.